Provider Demographics
NPI:1558007286
Name:RAINWATER, KRISTY DIANE
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:DIANE
Last Name:RAINWATER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 JOHN WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:CONNELLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28612-7338
Mailing Address - Country:US
Mailing Address - Phone:828-228-2705
Mailing Address - Fax:
Practice Address - Street 1:3445 JOHN WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:CONNELLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28612-7338
Practice Address - Country:US
Practice Address - Phone:828-228-2705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31362183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician